Filter Paper Samples Research Articles

Inborn errors of metabolism in Latin America: challenges and opportunities

Latin America includes more than 40 countries and possessions, and its population of 570 million has an important representation of the three main human races. The area is experiencing an economic improvement, progressively bringing the inborn errors of metabolism (IEM) to a higher level among health priorities. Challenges to the progress of the IEM field include the huge disparities, the high prevalence of malnutrition and infections, the co-existence of very different models of public health services, the unstable socio-economic and political conditions, and the difficulties in integrating the countries. However, a rapidly changing social and economic environment is presenting many opportunities to the IEM field, like the improvements in infrastructure, the concentration of the population in urban areas, the continuous growth of neonatal screening, the use of filter paper samples, the availability of internet communication, and the interest in IEM by the new population medical genetics discipline. Analyzing this picture, several proposals are presented, such as the development of activities of provision of health services, education and research as an integrated package, the increase in training of human resources, the expansion of access to diagnostic tests, and the use the neonatal screening framework to expand the provision of services. In a continent with few IEM centers, there is a major need for such groups to work in collaboration, complementing each other's capabilities, providing training of human resources, and developing joint projects. The integration of these groups into a large transnational network of reference centers would be a major task for the coming years.

Diagnosis of Streptococcus pneumoniae and Haemophilus influenzae Type b Meningitis by Identifying DNA From Cerebrospinal Fluid-Impregnated Filter Paper Strips

Bacterial meningitis remains often etiologically unconfirmed, especially in resource-poor settings. We tested the potential of real-time polymerase chain reaction to identify Streptococcus pneumoniae (Pnc) and Haemophilus influenzae type b (Hib) from cerebrospinal fluid impregnated on filter paper strips. Pnc and Hib genome equivalents were blindly quantified by polymerase chain reaction from 129 liquid cerebrospinal fluid (CSF) samples-the standard-and strips stored at room temperature for months. Genome counts were compared by simple regression. The strips showed a sensitivity and specificity of 92% and 99% for Pnc, and of 70% and 100% for Hib, respectively. The positive and negative predictive values were 94% and 97% for Pnc, and 100% and 89% for Hib, respectively. For Pnc, the positive and negative likelihood ratio was 92 and 0.08, and the overall accuracy 98%, whereas for Hib they were 70 and 0.30, and 91%, respectively. Genome counting showed good correlation between the filter paper and liquid CSF samples, r(2) being 0.87 for Pnc and 0.68 for Hib (P < 0.0001 for both). Although not replacing bacterial culture, filter paper strips offer an easy way to collect and store CSF samples for later bacteriology. They can also be transported in standard envelops by regular mail.

Applicability of the Filter Paper Technique for Detection of Antifilarial IgG(4) Antibodies Using the Bm14 Filariasis CELISA.

Demonstration of successful elimination of lymphatic filariasis (LF) in endemic countries requires sensitive diagnostics for accurate definitions of endpoints and future surveillance. There has been interest in complementing available diagnostics with antibody serology testing in children, since negative serology would correspond with cessation of LF transmission. The Filariasis CELISA detects antifilarial IgG4 and has favourable results with serum samples but field application requires an easier sampling method. Ninety-four paired plasma and filter paper samples were assayed with promising results. The filter paper method resulted in a sensitivity of 92% and a specificity of 77% when compared to the paired plasma. One hundred and one filter paper samples were assessed for storage effects. Following 10-month storage at −20°C there was a significant reduction in reactivity (P < .001). Overall the results indicated that filter paper sampling would be a favourable sensitive and specific alternative for blood collection in surveys.

Screening for inborn errors of metabolism using automated electrospray tandem mass spectrometry: Study in high-risk Indian population

Objectives: Tandem mass spectrometry is a major technological advance in the screening for inborn errors of metabolism. It has the advantage of sensitive and simultaneous multiple disease screening with minimal sample requirement. The diseases detected include aminoacidemias, fatty acid oxidation disorders, and organic acidemias. Design and methods: Using automated electrospray tandem mass spectrometry we screened 3550, clinically selected, symptomatic children for inborn errors of metabolism by analyzing amino acids and acylcarnitines in dried blood filter-paper samples. Results: Among these, 113 (3.2%) children were identified with a metabolic disorder: 61 (54%) patients had amino acid disorders, 47 (41.6%) had organic acidemias, and 5 (4.4%) children had disorders of fatty acid oxidation. The diagnoses were further confirmed through clinical symptoms, and other biochemical studies. Conclusions: These results show that inherited metabolic disorders are not rare in India, a rapidly developing country with a high birth rate and relatively frequent occurrence of consanguineous marriages.

Low-high season variation inPlasmodium falciparumerythrocyte binding antigen 175 (eba-175) allelic forms in malaria endemic area of Burkina Faso

To assess the impact of seasonal variation on the distribution of the eba-175 allelic forms in the area where malaria transmission is markedly seasonal. Blood samples were collected from 291 and 239 children under 5 years of age during the low and the high malaria transmission season, respectively, in four villages named Dawelgué, Kounda, Tanghin and Watenga of Saponé Health District, then screened for eba 175 F- and C- alleles by nested PCR analysis. F- alleles were more prevalent than C-alleles in the low [0.66 vs. 0.34 (P < 0.0001)] and high transmission season [0.67 vs. 0.33 (P < 0.0001)]. No significant seasonal variation was observed in the distribution of the two alleles. However, according to Sewall Wright rules, the population pairwise F(ST) values, between Dawelgué and Tanghin during the low transmission season (F(ST_) value = 0.10415, P-value = 0.0090 and during the high season (F(ST_)value = 0.08244, P-value < 0.00001), between Tanghin and Watenga during the low season (F(ST) value = 0.07414, P-value = 0.009) indicated a moderate but statistically significant genetic differentiation. Although there was a moderate but significant genetic differentiation between some study villages at different times of the year, this study result in the seasonal stability of eba-175 allele's distribution in the study area.

A simple cost-effective high performance liquid chromatographic assay of sulphadoxine in whole blood spotted on filter paper for field studies

BackgroundArtesunate plus sulphadoxine-pyrimethamine is one of the four artemisinin-based combination therapies currently recommended by WHO as first-line treatment for falciparum malaria. Sulphadoxine-pyrimethamine is also used for intermittent preventive treatment for malaria in pregnancy. Drug use patterns and drug pharmacokinetics are important factors impacting the spread of drug resistant parasites hence it is imperative to monitor the effect of pharmacokinetic variability on therapeutic efficacy. Unfortunately, information on the pharmacokinetics of sulphadoxine in children and pregnant women with malaria is very limited. Methods for the assay of sulphadoxine-pyrimethamine have been previously reported, but they are not cost-effective and practicable in analytical laboratories in low resource areas where malaria is endemic. Efforts in this study were thus devoted to development and evaluation of a simple, cost-effective and sensitive method for quantification of sulphadoxine in small capillary samples of whole blood dried on filter paper.MethodsSulphadoxine was determined in whole blood by reversed-phase high performance liquid chromatography with UV detection at 340 nm. Sulisoxazole (SLX) was used as internal standard. Chromatographic separation was achieved using a Beckman Coulter ODS C18 and a mobile phase consisting of 0.05 M phosphate buffer-methanol-acetonitrile (70:17:13 V/V/V) containing 1% triethylamine solution.ResultsStandard curves from sulphadoxine-spiked blood added to filter paper were linear over the concentration range studied. Linear regression analysis yielded correlation coefficient r2 > 0.99 (n = 6). Extraction recoveries were about 82-85%. The limit of quantification was 120 ng/ml while the within and between assay coefficient of variations were < 10%. The inter-day precision was < 5.8% and inter-day accuracy ranged from 4.1 to 5.3%. There was no interference from endogenous compounds or any of the commonly used anti-malarial, analgesic and anti-infective drugs with the peaks of SDX or the internal standard.ConclusionThe recovery and accuracy of determination of SDX from whole blood filter paper samples using the method described in this study is satisfactory, thus making the method a valuable tool in epidemiological studies and therapeutic drug monitoring in developing endemic countries. Furthermore, the applicability of the method in studying the pharmacokinetic disposition of SDX in a patient suggests that the method is suitable in malaria endemic areas.

Diagnóstico de hemoglobinopatías a partir de sangre del talón de recién nacidos en diferentes centros hospitalarios de Venezuela

Objectives Hemoglobinopathies are the most common hereditary disorders in humans representing a public health problem in Venezuela. In this study the prevalence of hemoglobinopathies was evaluated in newborns from different areas of Venezuela, in cooperation with the neonatal screening system of the Study Unit of Inborn Errors of Metabolism (IDEA). Materials and methods The heel blood samples of 101,301 newborns were analysed by high performance liquid chromatography (HPLC-CE) technique using Variant* Bio Rad System with the Sickle Cell Short program for the filter paper samples in and the Beta Tal Short program for the family studies. Results We found a high prevalence of newborns heterozygous for hemoglobin S and C (Hb S and Hb C). It was observed that 1.96% (1989) of the newborns were carriers, with Hb FAS (67.92) being the most frequent phenotype, followed by Hb FAC (23.18%), Hb FAD (7.49%), Hb FSC (0.96%),) and Hb FSD (0.20%). All the neonatal positives cases were confirmed at 3 months of age. Conclusions The frequencies of the variants found in this study confirms that the hemoglobin disorders are a public health problem in Venezuela, emphasizing the importance of instituting a national program of screening for hemoglobinopathies throughout the country, comprising not only an early treatment, but also an educational program and genetic counseling for the family group.

Design and construction of an ultra-low-background 14-crystal germanium array for high efficiency and coincidence measurements

Physics experiments, environmental surveillance, and treaty verification techniques continue to require increased sensitivity for detecting and quantifying radionuclides of interest. This can be done by detecting a greater fraction of gamma emissions from a sample (higher detection efficiency) and reducing instrument backgrounds. A current effort for increased sensitivity in high resolution gamma spectroscopy will produce an intrinsic germanium (HPGe) array designed for high detection efficiency, ultra-low-background performance, and useful coincidence efficiencies. The system design is optimized to accommodate filter paper samples, e.g. samples collected by the Radionuclide Aerosol Sampler/Analyzer (RASA). The system will provide high sensitivity for weak collections on atmospheric filter samples, as well as offering the potential to gather additional information from more active filters using gamma cascade coincidence detection. The current effort is constructing an ultra-low-background HPGe crystal array consisting of two vacuum cryostats, each housing a hexagonal array of 7 crystals on the order of 70% relative efficiency per crystal. Traditional methods for constructing ultra-low-background detectors are used, including use of materials known to be low in radioactive contaminants, use of ultra pure reagents, clean room assembly, etc. The cryostat will be constructed mainly from copper electroformed into near-final geometry at PNNL. Details of the detector design, simulation of efficiency and coincidence performance, HPGe crystal testing, and progress on cryostat construction are presented.

Preliminary study of malaria incidence in Nouakchott, Mauritania

BackgroundMalaria is one of the main motives for outpatient consultation and hospitalization in Mauritania. However, its incidence remains unclear because of diagnostic problems and insufficient epidemiological data.MethodsBetween April and August 2007, a study on malaria incidence was carried out in Nouakchott city. A total of 237 febrile outpatients, from all Nouakchott districts, attending the two main hospitals of the city were investigated. Finger prick and blood dried filter paper samples were performed to prepare thick and thin films and nested-PCR for malaria parasite species identification and density. The accuracy of diagnosis of 'presumptive malaria', assigned by clinicians and based on fever and other malaria suggestive symptoms, was assessed. Entomological investigations based on morphological and molecular characterization of Anopheline species were conducted in Dar Naïm district.ResultsMalaria prevalence rate was 25.7% (61/237), the majority of positive blood slides as well as nested-PCR products were due to Plasmodium vivax 70.5% (43/61) and Plasmodium ovale 24.6% (15/61). Two malaria patients, both with P. vivax, have never travelled out of Nouakchott and seem likely to have been autochthonous (3.3%). Of the 237 individuals included in the survey, 231(97.5%) were clinically diagnosed and treated as malaria cases. 26.4% of clinically diagnosed cases were positive for Plasmodium using microscopic examination and PCR. Thus, false positive cases constituted 73.6% (170/231) of the clinically diagnosed malaria cases. The search for mosquito vectors in Dar Naïm district allowed morphological and molecular identification of Anopheles arabiensis and Anopheles pharoensis.ConclusionThis study demonstrates that, during the hot and dry season, Plasmodium species responsible of recurrent malaria (P. vivax and P. ovale) are the dominant species in Nouakchott city and autochthonous malaria cases exist but are rare. Clinical diagnosis of malaria has a very low positive predicted value. The systematic use of microscopy-based diagnosis and/or rapid diagnostic tests should be considered to appropriately manage malaria and non-malaria cases.

PCR diagnosis of visceral leishmaniasis in an endemic region, Mymensingh district, Bangladesh

Detection of Leishmania parasites in a clinical sample is necessary to confirm a suspected case of leishmaniasis. We compared the sensitivity of internal transcribed spacer 1-PCR (ITS 1-PCR) assay for parasite diagnosis with that of microscopic detection in clinical samples from kala-azar (KA) or post-kala-azar dermal leishmaniasis (PKDL) suspects in Mymensingh. Of 39 specimens collected from 35 KA and four PKDL suspects, 26 were positive by microscopic examination of smears from bone marrow and skin exudates; 38 specimens spotted on filter paper and 27 of the 28 Giemsa-stained slides tested by PCR proved positive by ITS1-PCR.

Field experiments to assess approaches for spray drift incident investigation

Spray trials were conducted to determine the variation in primary spray drift deposition between trials under very similar conditions, in order to assess the feasibility of developing a computational tool to aid post-event investigations of pesticide spray incidents. Pesticide deposition was examined by analysis of filter paper and vegetation samples. Considerable variation in the drift profile was found. The overall estimate of the spray drift decay term was -1.13 (95% confidence interval -1.02 to -1.24), with statistically significant differences between plots. Variation in the drift profile between neighbouring essentially identical plots indicates the variation in deposition that might be expected over small distances. Vegetation samples were found to have considerably lower capture efficiency than filter papers. Importantly, degradation of pesticides was found to have little effect on the pesticide drift profile over a 14 day period. The levels of spatial variation in spray drift deposits between runs and plots observed in this study suggest serious limitations to the inferences that may be drawn from limited numbers of post-incident samples. In particular, they would limit inferences about the spray conditions that could be drawn from an estimate of the drift profile derived from limited post-incident samples.

A reference interval for sweat chloride in infants aged between five and six weeks of age

This study was designed to establish a reference interval for sweat chloride for infants without evidence of cystic fibrosis (CF), aged between 5 wk and 6 wk, a time when sweat testing is an integral part of newborn screening for CF. In addition, we compared the gold standard method of sweat testing (quantitative pilocarpine iontophoresis [QPIT, coulometry]) with an emerging methodology (Macroduct [ISE]). This was a prospective study on healthy infants at 5-6 wk of age. Sweat collection was undertaken at home on both outer thigh areas using two methods (QPIT and Macroduct ). The order of testing was randomly assigned. Filter paper samples (QPIT) were analysed using flame photometry and coulometry. Macroduct samples were analysed using ion-selective electrodes (ISE, Abbott Architect c8000, UK). Insufficient sweat was collected on 28 occasions with the QPIT (coulometry) method and on 31 with the Macroduct (ISE) capillary system. We achieved a 92% success rate in undertaking two sweat collections consecutively (n = 177). Sweat chloride concentrations were normally distributed with excellent limits of agreement between the two methods of sweat collection and analysis (n = 150). Median (IQR) sweat chloride was 11.2 mmol/L (8-13) with QPIT (coulometry) method with a 99.5th centile (n = 165) of 24 mmol/L. The Macroduct (ISE) capillary sweat collection system is valid in this age group. Sweat chloride concentrations above 30 mmol/L should prompt assessment in a specialist CF centre.

Effects of long-term storage of filter paper blood samples on neonatal thyroid stimulating hormone, thyroxin and 17-alpha-hydroxyprogesterone measurements

Clinical laboratories store filter paper samples used in neonatal screening for various periods of time after performing hormonal measurements. However, due to lack of data concerning specimen stability, it is unclear for how long these samples should be stored. The objective of this study is to determine the stability and reproducibility of thyroid-stimulating hormone (TSH), thyroxine (T(4)) and 17-hydroxyprogesterone (17-OHP) measurements in filter paper blood samples stored for up to 60 months. Two hundred and twenty-eight blood samples, drawn between the second and the fourth day of life, were divided into seven distinct groups and kept at 4-8 degrees C for one day or 2, 12, 24, 36, 48 or 60 months after basal hormonal measurements. In each group, TSH, T(4) and 17-OHP levels were initially assayed 24-48 hours after collection (basal) and repeated once at the end of storage timing. All the measurements were performed by time-resolved fluorometry (1235 AutoDELFIA, Wallac Oy, Turku, Finland). Repeated and basal levels of each hormone were compared within the same group by Student's paired t-test. Differences were considered significant at P < 0.05. Compared with basal measurements, TSH and T(4) levels declined significantly only when these hormones were re-assayed at 48 or 60 months of sample storage. In contrast, 17-OHP concentrations decreased earlier, starting at 24 months and continuing throughout the remaining period. Our data suggest that neonatal screening of filter paper samples kept at 4-8 degrees C are reliable for repeating the hormonal measurements when specimens are stored for up to one year, in the case of 17-OHP, or three years, in the case of T(4) and TSH.

Human growth hormone measurement by means of a sensitive ELISA of whole blood spots on filter paper

Background Measurements of human growth hormone (hGH) are a prerequisite for identifying a deficiency or excess. Our study is the first to investigate the reliability of a very sensitive assay for the quantification of GH in dried blood spots on filter paper. Objective Validation of a commercially-available enzyme-linked immunoassay (ELISA) for measuring hGH from filter paper samples of dried blood. Methods We used an assay system (ELISA, E022, Mediagnost) based on polyclonal rabbit antibodies. Its suitability is ascribable to its very high sensitivity (1.6 ng/L) and virtual absence of interfering factors, excepting for a cross-reactivity with high pegvisomant concentrations. Results hGH was found to be stable in dried blood spots on filter paper (No. 903, Whatman) over eight days at 37 °C. Extraction of hGH from filter paper, in comparison to EDTA plasma, was 107% (SD 8.1%; n = 6) over a range from 2.4 to 34.5 μg/L. Linear regression analysis ( n = 119) showed a correlation of R 2 = 0.97 for the hGH concentration in serum and on filter paper samples. Conclusion Our findings demonstrate the reliability of measurements of hGH in dried blood spots on filter paper. The advantages of this method are the low sample volume and the easy transport, storage, and handling of samples. This method contributes to the standardisation of diagnostics pertaining to abnormal hGH secretion as it facilitates the comparison of decisive measurements.

Cleaning of artificially soiled paper with 532-nm nanosecond laser radiation

Cleaning of paper is a challenging task due to the fact that a contamination should be removed and a fragile organic original material has to be preserved. Pulsed laser cleaning of artificially soiled Whatman© filter paper samples serving as models for historical paper was performed. Different cleaning strategies employing 8-ns laser pulses at 532 nm wavelength were applied to clean paper avoiding undesired effects like discoloration (yellowing) and mechanical deterioration of the substrate. Multi shot experiments with low-energy pulses were compared with single pulse investigations utilizing high pulse energies achieving a constant energy load incident on the samples in both cases. The cleaning efficiency and possible yellowing effects were evaluated by means of a multi spectral imaging system. An extensive microscopic analysis of the cleaned parts of the samples provided insight into the remaining soiling on the surface and in the bulk of the paper material after laser treatment. As a reference, a hard and a soft eraser were used to clean the samples.

Detection of cervical human papillomavirus infection in filter paper samples: a comparative study

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Dry Deposition of Polycyclic Aromatic Hydrocarbons Associated with Atmospheric Particulate Matters in an Urban Site, Mumbai, India

The rate of dry deposition of polycyclic aromatic hydrocarbons (PAHs) depends on the size of the particulate matter on which they are adsorbed. The distribution of PAHs on size-fractionated aerosol samples has been studied during winter and in the absence of precipitation to estimate the dry deposition flux of individual PAHs. Size-fractionated ambient particulate matter samples were collected during a 72-hour period, using an eight-stage cascade impactor. Filter paper samples were then extracted ultrasonically, and PAH characterization and quantification performed with a high-performance liquid chromatograph (HPLC) system with UV-visible detector. Total PAH concentrations associated with the size-segregated ambient particulate matters collected on different impactor stages were in the range of 18.3 to 66.6 ng/m3. The size distribution of atmospheric total PAHs was found to be bimodal. The modeled deposition velocity (Vd,i) at the sampling site for the particle size range of < 0.4 µm, 0.4-1.1 µm, 1.1-3.3 µm and 3.3-9.0 µm were found to be 0.004 cm/sec, 0.037 cm/sec, 0.283 cm/sec and 2.72 cm/sec, respectively. The dry deposition flux for individual PAHs at the sampling site was found to be in the range of 0.17 μg/m2/day-2.69 μg/m2/day. The results indicate that the dry deposition of PAHs is mainly due to gravitational settling of coarse particulates.

APPLICATION OF ION EXCHANGE PAPER TO PRECONCENTRATION OF CHROMIUM (III) AND CHROMIUM (VI) IN WATER FOR PIXE ANALYSIS

The most important species of chromium (VI) formed in water are anions such as CrO 42-, whereas chromium (III) is mainly present in the form of cationic species such as Cr ( OH )2+. Pure water and tap water samples were artificially contaminated with mixture of chromium (VI) and chromium (III) standard solutions. Sequential filtration through commercially available Whatman P81 cellulose phosphate paper and Whatman DE81 DEAE cellulose paper was employed for separation and preconcentration of chromium (III) and chromium (VI) in these water samples, respectively. The PIXE measurements of these filter paper samples were performed using 2-MeV proton beams delivered by a tandem pelletron accelerator at Research Laboratory for Nuclear Reactors, Tokyo Tech. The beam current and the measuring time for each sample were 1 nA and 10 minutes, respectively. Instrumental detection limits were 60 ng for chromium (VI) and 120 ng for chromium (III). Detectable range for chromium (VI) and chromium (III) in water were ≧ 10 ppb and ≧ 50 ppb, respectively. For chromium (VI), the detectable range was considerably lower than the maximum allowed concentration of 50 ppb for chromium (VI) in both the drinking water standards and the environmental quality standards in many countries.

Urinary C-peptide of insulin as a non-invasive marker of energy balance in wild orangutans

Assessment of energetic condition is a critical tool for behavioral and reproductive ecologists. However, accurate quantification of energy intake and expenditure is labor-intensive, and it can be problematic for field scientists to obtain regular data on individual animals. C-peptide, a polypeptide segment of the proinsulin molecule that is secreted along with insulin in an equimolar relationship, can be measured in urine, and thus offers a potential means for the non-invasive assessment of energy balance in wild animals. Here, we validate C-peptide for the quantification of energetic condition, with specific application to wild orangutans ( Pongo pygmaeus). We determined that application of urine to filter paper results in significantly lower C-peptide recoveries versus fresh samples. However, concentrations in filter paper samples were significantly correlated with fresh urine and were stable over various storage conditions and durations. We compared the C-peptide concentrations from wild orangutan urine samples with three independent measures of energetic condition: ketone bodies (urinalysis), caloric intake (nutritional biochemistry), and food availability (phenology). As expected, C-peptide concentrations were significantly lower in samples that tested positive for ketones in the field. Monthly average C-peptide concentrations of both male and female orangutans were significantly correlated with monthly determinations of energy intake and food availability. Therefore, we conclude that the collection and preservation of urine samples for C-peptide analysis are feasible under most field conditions and, in this species, presents a useful tool for assessing changes in energy balance.

Congenital toxoplasmosis: late pregnancy infections detected by neonatal screening and maternal serological testing at delivery

The first aim of this study was to determine the prevalence of congenital toxoplasmosis in newborn infants treated by the public health system in Porto Alegre, a city in southern Brazil, using neonatal screening for Toxoplasma gondii-specific IgM. The second aim was to investigate whether the cases detected by this approach could have been identified by the prenatal screening for antibodies to T. gondii that was performed in the same population. A fluorometric assay was used to analyse T. gondii-specific IgM in filter paper specimens obtained from newborn infants for routine screening for metabolic diseases. When the specific IgM was positive, serum samples from the infant and the mother were requested for confirmatory serological testing, and the infant underwent clinical examination. Among 10 000 infants screened for T. gondii-specific IgM, seven filter paper samples were positive, and congenital toxoplasmosis was confirmed in six patients. The prevalence of IgM specific for T. gondii was 6/10 000 [95% CI 2/10 000, 13/10 000]. One infected infant had already been identified in the maternity ward before birth, three had been identified by maternal serology at delivery, and two infants with congenital toxoplasmosis were identified solely through neonatal screening. Although four mothers of the patients with congenital toxoplasmosis received prenatal care, and three mothers had one or two serological tests for T. gondii-specific antibodies (one at first trimester, one at first and second trimesters, and the other at second and third trimesters), they were not identified during pregnancy as infected. Neonatal screening identified cases of infection not detected by obtaining only one or two serum samples from pregnant women for T. gondii serology, mainly when infection was acquired and transmitted in late pregnancy. Maternal serology at delivery and neonatal screening were especially useful in the identification of infants with congenital toxoplasmosis when the mother did not receive regular prenatal serological testing or prenatal care.